The tear trough
The tear trough is the groove or valley that begins at the inner corner of your eyes and travels down and out across your cheek. It’s often blamed for under-eye dark circles and an aged appearance. Some doctors will even go as far to call it a “deformity”.
Photo of the tear trough (circled), from my book Pause and Reverse
Why the tear trough is not a deformity
The tear trough is a valley that sits atop the rim of bone that encircles the eye. This valley is a natural and normal contour that is caused by an area of compressed tissue layers. There is a thinner fatty layer over the tear trough than there is in the plumpest part of the cheek. The cheek can only look round if the surrounding areas are less round. In other words, different parts of the face must have different heights and contours in order to have recognizable structure.
The image below is of my 2-year-old son. He has a tear trough. Clearly this is not a deformity and it is not a sign of aging.
When does it make sense to fill the tear trough?
So you can see that your tear trough is not an enemy to be eradicated, but it can be a youthful contour. So when can it be filled with an injection like Restylane to brighten the eyes? In the following circumstances:
- the tear trough has deepened with age
- the under-eye fat pouches have enlarged and accentuated the hollow area below
- the tear trough in combination with a deep-set eye is creating dark shadows
I like to take a conservative approach by filling the tear trough with a cannula (instead of a sharp needle) and by avoiding overcorrection which can lead to a puffy appearance with distortion of the natural-looking under-eye contours and sometimes a bluish-hue called the tyndall effect.
Here are examples of filler to reduce the under-eye concavity without obliterating it:
Tear trough filler in NYC
Under-eye filler is one of the most requested procedures in my office in NYC and I take pride in performing this treatment with the skill of a cosmetically-trained eyelid and face surgeon. I especially enjoy when first-time filler patients are instantly amazed when they see their results in the mirror. I’m even more pleased when they come back and tell me that nobody even noticed they did it. That’s the point – to look younger, refreshed, less tired, but not done.